CMS on Tuesday released the final 2011 Medicare Physician Fee Schedule. I wish I could say I had good news to report, but it’s just more bad news for fee-for-service. This rule covers all the payment details for next year and starts the process of implementing many of the provisions of the reform bill that passed earlier this year. Overall, the rule is nowhere near as bad as 2010, but it still contains cuts (including the 2^nd year phase-in of the practice expense cuts) for cardiovascular services.

As it has for the last many, many years, the Rule announces a reduction to payment rates for physicians' services in 2011 under the sustainable growth rate (SGR or SGRrrr as I like to call it) formula.  The SGRrrr is currently scheduled to be reduced on Dec. 1, and then again on Jan. 1, 2011 under current law.  The total SGRrrr cut? 24.9 percent between November and January. This is not surprising – we’ve had to fight to reverse these cuts every year since 2003. What IS surprising is that CMS Administrator Don Berwick, MD, in the press release announcing the Rule, says that this SGR madness needs to stop – something that the ACC and other medical specialties have been saying for a long time. Berwick says:

“Broad physician participation in Medicare is essential to ensuring that beneficiaries continue to have access to care, and physician engagement is critical to our efforts to strengthen the quality of care... Medicare needs to be a strong, dependable partner with physicians – and that means the SGR must be fixed.  The Administration supports permanently reforming the Medicare payment formula.”

This is huge. Maybe we’ll finally be able to work toward a solution for creating a new payment system.

For Those Who Want the Details of the Rule
The Rule includes changes in payment rates for new bundled diagnostic cardiac catheterization codes and new lower extremity revascularization codes. As part of CMS’ ongoing bundling trend, most services that were previously reported with a series of 3-5 codes will now be reported with a single code. While the actual payment changes for these services are difficult to calculate, overall, lower extremity revascularization services received more significant payment cuts than diagnostic cardiac catheterization services. (For more on the extensive coding changes and how to use them, please join your ACC and SCAI for a special webinar on Wednesday, Dec. 1 at 3:30 p.m. to 5:00 p.m. (ET). More information will be coming soon.) [more]

CMS also finalized its decision to revise and rebase the Medicare Economic Index, a formula adjustment that affects all services paid under the physician fee schedule. This decision has a modest impact on cardiology overall, but does slightly moderate projected cuts to imaging services such as echocardiography that are scheduled to be implemented in 2011. However, it moderates projected increases in services such as office visits. The impact of this change depends on the mix of services provided in the practice.

Primary care does get some much-needed incentives under this rule, including implementation of a 10% bonus payment to primary care physicians, who are determined based on specialty and the kinds of services that are provided.   General surgeons who practice in shortage areas will be getting a similar bonus.  In addition, the new health reform law provides for coverage of an annual wellness visit, the details of which are addressed in this rule. While some cardiologists may provide this service to their patients in certain circumstances, it is more likely to be used by primary care physicians. 

The rule also finalizes requirements for receiving bonuses for the Physician Quality Reporting System (PQRS), formerly PQRI, and the disclosure of ownership for CT/MR.  In terms of PQRS, CMS continues to make changes to the program, moving the system away from claims-based reporting and further towards registry and electronic health record reporting.  Already, most of the ACC developed performance measures in PQRS are only reportable through a registry, such as PINNACLE or the ACC PQRI Wizard.  In addition, the rule sets the stage for a payment reduction for those who do not use e-prescribing systems, starting in 2012. Providers who aren’t e-prescribing by June 30, 2011, will have their Medicare payments reduced by 1 percent starting in 2012. The decrease in payment only gets bigger in future years, so start e-prescribing, folks!

The College will be providing more details on all of these topics in the coming weeks. Stay tuned to CardioSource.org for more information as it becomes available.

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